Chiropractic billing and accounts receivable

Chiropractic revenue turns on high-frequency, low-dollar visits: spinal and extraspinal manipulation, the initial exam, re-evaluations and the therapy billed around them. The code set is narrow. The money is lost in documentation and in benefit limits, because plans cap visits and separate active treatment from maintenance, and the note has to carry that distinction every visit.

Where the money leaks in chiropractic

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• Manipulation billed for more spinal regions than the day's note supports, with the regions adjusted listed but the findings behind each one absent
• The adjustment recorded without the level of subluxation, or without the tenderness, asymmetry, range-of-motion and tissue-tone findings that establish it
• Care that has plateaued into maintenance still billed as active treatment: same complaint, same findings, visit after visit, and no self-pay agreement in place
• An exam billed the same day as manipulation when the note reads as the pre-adjustment assessment rather than a separately identifiable evaluation
• Modalities and timed therapy billed alongside manipulation on the same region, with no distinct-service rationale and no treatment minutes in the note
• The plan's annual chiropractic visit allowance already exhausted, because benefits were verified once at intake and never re-checked at the encounter

What a seat does about it

One trained person works your queue from the difficult end. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing.

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and certified coding at $2,500.

The codes those turn into

Each of these is a denial code you are likely to meet working chiropractic, matched to the problem above it in your own words. The route back to payment differs by code, so a queue sorted by recovery route clears faster than one sorted by date.

• CO-252 — Additional documentation required
  The payer will not decide until it sees paperwork. Nothing happens until it arrives.
  Recovered by being answered with the document the payer names. Matched from: “Manipulation billed for more spinal regions than the day's note supports, with the regions adjusted listed but the findings behind each one absent”
• CO-198 — Authorization limit exceeded
  An authorization exists. The problem is that you went past what it allowed — more units, more visits, or a longer date range than was approved.
  Recovered by being answered with the document the payer names. Matched from: “An exam billed the same day as manipulation when the note reads as the pre-adjustment assessment rather than a separately identifiable evaluation”
• CO-226 — Requested information not supplied
  The payer asked you for something, and either nothing arrived or what arrived did not answer the question.
  Recovered by being answered with the document the payer names. Matched from: “Modalities and timed therapy billed alongside manipulation on the same region, with no distinct-service rationale and no treatment minutes in the note”

Working a denied claim costs $57.23 per denied claim in administrative time (source), and about about 90% of initially denied claims are eventually paid. Most of what sits in a chiropractic AR bucket is not lost money. It is money waiting for somebody with the hours to make the call.

Questions